Gou in the operating room to add some upgrades

Chapter 15 Heard again! ~ (Please collect it, please recommend it)
After reaching level 3 of the basic basic theory of surgery and general theory of orthopedics, Fang Xian was not allowed to rise on the spot.

However, in terms of the breadth of knowledge, Fang Xian has greatly improved.

Fang Xian also found that after the basic theoretical level of orthopedics was improved, the theoretical levels of other sub-specialties such as joint surgery, sports medicine, orthopedics, hand surgery, and foot and ankle surgery also advanced.

Although it has not reached level 2, it will be full at level 1.

You only need to spend 1 to 2 skill points to upgrade to level 2 at any time!
According to statistics, the overall improvement of several theories is slightly higher than 50 skill points, specifically 56 points.

The basic theory of surgery has been upgraded to level 3, and the related basic theories such as neurosurgery and vascular surgery have also been improved to a certain extent. The overall progress of the improved skills is about 60 points.

It is easy to come up with a rule -

Improving the foundation first will increase the utilization efficiency of skill points.

However, improving basic skills first will not bring much benefit to the sub-specialty skills, but it can save skill points.

There are pros and cons to belonging.

……

After Fang Xian put all the postoperative doctor's orders of the 15-bed patient in order!
I saw that the 14-bed patients in my charge had completed the discharge procedures and the beds were already vacant.

Because she was in the operating room before, she couldn't find her to say goodbye or think about it when she and her family left.

In any case, new patients have been admitted to the 14-bed hospital.

After reading the basic information of the 14 new patients, Fang Xian picked up a pen and notebook and walked to the room where the bed in charge was located.

Before entering the door, he rubbed his hands with hand sanitizer and walked towards the fourteenth bed.

At this moment, an aunt who was probably in her 40s was lying down on the bed with the help of her daughter.

When Fang Xian walked in, the family members of Bed 15 and Bed 13 enthusiastically called Dr. Fang Xian.

Fang Xian only smiled and nodded at them, and walked to bed 14: "Hi auntie, I am your bed doctor, my surname is Fang, you can call me Doctor Fang."

The aunt in bed 14 is small, thin and has dark skin. She probably works outdoors all year round.

When she saw Fang Xian, she tried to sit up: "Hi Doctor Fang, I..."

"Auntie, don't sit up, you lie down, I'm here to ask about your basic situation. By the way, register and confirm your medical insurance. You just need to lie down and rest. You only need to lie down during the physical examination. "Fang Xian stretched out his right hand as a soothing gesture.

Then she said to her daughter: "Then you can raise the bed a little, and it will be about [-] degrees."

Fang Xian had seen her diagnosis when he came. It was a comminuted fracture of the tibial plateau. There was no pelvic fracture. She could be placed in a semi-recumbent position!
Her daughter is about 20 years old, her skin is wheat-colored like her mother’s, and she has a good figure!

Today, for convenience, I deliberately wore a pair of loose black straight-leg pants, and the top is matched with a white short-sleeved shirt.

She nodded when she heard the words: "Okay Doctor Fang."

Walked to the end of the bed and began to shake the bed, and laughed at the other party, and the smile was a little 'flattering', the little melon seed had a few freckles on his face, and his face was nervous and shy.

Fang Xian asked about the current medical history, and learned that this aunt was delivering food in Shashi.

The injury happened five days ago when I was delivered to the sixth floor of a stairway room. After delivering the food, I ran down the stairs in a hurry and slipped down without stepping on it.

She fell to her knees on the stairs and slipped all the way to the corner. Fortunately, she finally supported the wall with both hands and did not hurt her head.

The history of trauma was clear.

After being injured, I couldn't move. I called 120 before being sent to the nearest small hospital. I was diagnosed with a comminuted fracture of the tibial plateau and was currently covered by work-related injury insurance.

After finishing speaking, her daughter added: "At first, my mother said that she would do surgery at Kangping Hospital, and thought the cost was cheap, but my father and I were worried about the quality of surgery in that hospital! I came to visit Professor Song's outpatient clinic three days ago. Queue to the hospital."

"I've been injured for almost 6 days!"

Fang Xian quickly explained: "I'm sorry, we have a lot of patients here, and everyone queues up like this, and they line up according to the appointment time of the outpatient clinic. If it's not a special emergency to rescue patients, they all queue up!"

"I know, I came to the ward to see it in advance." Yang Zilu replied with a smile, and even tidied up her messy bangs a little.

After hearing Yang Zilu's words, her mother felt a little guilty: "Doctor Fang, when can I have the surgery? I should have asked my husband to come over and take care of me earlier. My daughter is still a student and is only a sophomore."

"She has asked for a week off, and I'm afraid she won't be able to keep up with other people's learning progress."

Fang Xianwen said, "If there is no problem in the preoperative examination after you are admitted to the hospital, the operation is expected to be scheduled for Thursday or Friday."

"Can't you do it tomorrow?" she asked.

"Not tomorrow. Tomorrow is not the day of surgery for our team, and the preoperative examination results are still difficult to complete. Have you had any underlying diseases before? Or have you ever been hospitalized?" Fang Xian asked as he replied.

"My mother has not been in good health. She has not been hospitalized. She just eats irregularly and often has stomach pains. Every time there are a lot of takeaway orders at meal times, she often forgets to eat." Yang Zilu helped explain, looking at her mother's eyes and complaining. Distressed.

"What medicine are you taking now?" Fang Xian asked again.

"What is it called Pantuo? I don't quite remember." Yang Zilu was a little embarrassed.

"Pantoprazole, is this the only medicine?"

"At present, I only take this medicine. I have a physical examination every year, and no diseases such as three highs have been found." Yang Zilu is not a medical professional, so she doesn't know much about it.

"Okay, I already understand the basic situation. I will give you a detailed physical examination. Auntie!" Fang Xian recorded all the basic information.

Start doing physical examination and film reading.

These are an essential step in seeing a patient.

In the emergency department, the physical examination is performed first, followed by the consultation.Symptoms need to be checked first.

For ordinary patients, consultation is done first, followed by physical examination.Need to determine the direction first.

There is basically no special physical examination for the right lower limb. After swelling and plaster external fixation, the dorsalis pedis artery can be palpable!It is obvious that active activities do not cooperate.

So Fang Xian planned to do another heart, lung and abdomen related examination, which has always been a problem easily overlooked by surgery.

After closing the curtain, Fang Xian said: "Auntie, I'm sorry, we currently don't have a female doctor in the orthopedics department, so I can only give you a simple physical examination related to the heart, lungs and abdomen. This will not involve any special privacy. parts!"

This point must be explained clearly. There are no female doctors in the orthopedics department. It is not because he wants to take advantage!

This was also explained to other patients in the ward to avoid any misunderstandings.Her daughter was with her.

Complying with laws and regulations.

Regarding the heart and lungs, Fang Xian only auscultated the apex of the lungs and the back of the lungs. He did not hear any special rales or solid sounds, so he did not continue the examination!
Regarding the heart, Fang Xian auscultated the heart rate from under the right diaphragm and felt the pulse rate with his hand!

Determine if they are consistent.This is very important. If the heart rate and pulse rate are irregular, in most cases she will have to go to cardiac surgery.

But this rare symptom did not occur.

After the cardiopulmonary examination ruled out serious disease indications, Fang Xian went to the abdominal examination.

Audio-visual tapping is a routine physical examination sequence, but surgical physical examinations are generally not formatted like this!
They will only do a simple palpation, and if there is any suspicion of a problem, they will continue with a detailed physical examination.

Palpation starts from the left lower abdomen and checks in a counterclockwise direction, that is, the left lower abdomen, left upper abdomen, right upper abdomen, and right lower abdomen!

But when Fang Xian palpated the upper left abdomen, he felt something was wrong.

This place is very hard and does not have the soft feeling of abdominal palpation.

Fang Xian's expression flickered slightly.

Then I continued to check the right upper quadrant and right lower quadrant, and found that there was also a feeling of abdominal stiffness in the right upper quadrant.But not in the right lower quadrant.

"Auntie, did you feel any pain before or after you ate recently?" Fang Xian said in a tight tone.

"No!~" Auntie shook her head.

"Then will it hurt if you press it like this?" Fang Xian asked again.

The aunt continued to shake her head.

Fang Xian started to have a headache.

Painless lumps have a worse prognosis than painful lumps.

"Then when you were hospitalized, did you have any abdominal examinations?" Fang Xian asked again.

Yang Zilu shook her head: "I heard that the Affiliated Hospital of Shonan University doesn't recognize the test results from other hospitals, so we didn't check it. We just checked the film on the leg."

This is what I heard again——

"You guys go down and get a chest and abdomen X-ray first, and go right away!" Fang Xian said very seriously.

(End of this chapter)